What We Lose Without Health Reform - Medicare Rights Center

Asclepios - Your Weekly Medicare Consumer Advocacy Update from the Medicare Rights Center
January 21, 2010 • Volume 10, Issue 3

Both the House and Senate passed far-reaching health care reform bills last year, but the election of Massachusetts Republican senator Scott Brown this week makes it more difficult—but not impossible—to pass final legislation that reconciles the differences between the House and Senate bills. There are a number of procedural options for passing a health reform bill that has the support of a majority in both the House and the Senate and that President Obama would sign. What should not be an option is giving up on health care reform.

Older adults and people with disabilities in particular will lose if the Medicare improvements in health reform are not implemented.

People with Medicare now face a gap, or “doughnut hole,” in their drug coverage, when their benefits stop and they must pay the full price for their drugs in addition to the premiums for drug coverage. In 2010, people must spend nearly $4,000 out of pocket to get out of the gap; most never get out and many split pills or stop taking their medicine instead. If we give up on health reform, that coverage gap will grow to more than $7,000 by 2019. Senate leaders and President Obama have promised that the final bill will include a phase-out of the coverage gap by 2019, which is already part of the House health reform bill.

Medicare provides coverage for the treatment of illness and injury, but it falls short in providing affordable coverage of preventive care. Both the House and Senate bills eliminate deductibles and coinsurance for preventive benefits, and the Senate bill would provide 100 percent coverage for an annual health assessment.

One in five people with Medicare who are discharged from the hospital are readmitted within 30 days. Preventable readmissions cost Medicare $12 billion every year. Both the House and Senate bills provide incentives to hospitals to improve care after discharge and for specialists and primary care doctors to improve the coordination of care.

People with Medicare aren’t the biggest losers if Congress gives up on health reform. Over 20,000 people in the U.S. die each year because they lack health insurance, according to the Urban Institute. There are now 50 million people with no health insurance in our country. If we give up on health reform, that number will grow to 54 million in ten years, according to the Congressional Budget Office. Both the House and Senate bills would cover more than 90 percent of U.S. residents.

People who can’t get health benefits through their jobs, or who lose their insurance when they lose their jobs, can now be denied coverage if they have a pre-existing condition. Both the House and Senate bills would make this practice illegal. If we give up on health reform, insurance companies will be able to continue to deny coverage to the people who need it most—those with illnesses needing treatment.

These are the essential elements of health reform: covering the uninsured, prohibiting unfair insurance company practices and improving Medicare. We can’t give up now. We have too much to lose.
Medicare Rights Center

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